Multiparametric 3T MRI for the prediction of pathological downgrading after radical prostatectomy in patients with biopsy-proven Gleason score 3 + 4 prostate cancer Journal Article


Authors: Gondo, T.; Hricak, H.; Sala, E.; Zheng, J.; Moskowitz, C. S.; Bernstein, M.; Eastham, J. A.; Vargas, H. A.
Article Title: Multiparametric 3T MRI for the prediction of pathological downgrading after radical prostatectomy in patients with biopsy-proven Gleason score 3 + 4 prostate cancer
Abstract: Objectives: The aim of this study was to assess the diagnostic performance of pre-treatment 3-Tesla (3T) multiparametric magnetic resonance imaging (mpMRI) for predicting Gleason score (GS) downgrading after radical prostatectomy (RP) in patients with GS 3 + 4 prostate cancer (PCa) on biopsy. Methods: We retrospectively reviewed 304 patients with biopsy-proven GS 3 + 4 PCa who underwent mpMRI before RP. On T2-weighted imaging and three mpMRI combinations (T2-weighted imaging + diffusion-weighted imaging [DWI], T2-weighted imaging + dynamic contrast-enhanced-MRI [DCE-MRI], and T2-weighted imaging + DWI + DCE-MRI), two radiologists (R1/R2) scored the presence of a dominant tumour using a 5-point Likert scale (1 = definitely absent to 5 = definitely present). Diagnostic performance in identifying downgrading was evaluated via areas under the curves (AUCs). Predictive accuracies of multivariate models were calculated. Results: In predicting downgrading, T2-weighted imaging + DWI (AUC = 0.89/0.85 for R1/R2) performed significantly better than T2-weighted imaging alone (AUC = 0.72/0.73; p < 0.001/p = 0.02 for R1/R2), while T2-weighted imaging + DWI + DCE-MRI (AUC = 0.89/0.84 for R1/R2) performed no better than T2-weighted imaging + DWI (p = 0.48/p > 0.99 for R1/R2). On multivariate analysis, the clinical + mpMRI model incorporating T2-weighted imaging + DWI (AUC = 0.92/0.88 for R1/R2) predicted downgrading significantly better than the clinical model (AUC = 0.73; p < 0.001 for R1/R2). Conclusion: mpMRI improves the ability to identify a subgroup of patients with Gleason 3 + 4 PCa on biopsy who are candidates for active surveillance. DCE-MRI (compared to T2 + DWI) offered no additional benefit to the prediction of downgrading. Key Points: • Diagnostic performance of T2-weighted-imaging + DWI was better than T2-weighted-imaging alone. • Diagnostic performance of T2-weighted-imaging + DWI was similar to T2-weighted-imaging + DWI + DCE-MRI. • Combining clinical and T2-weighted-imaging + DWI features best predicted GS downgrading. • mpMRI might prevent overtreatment by increasing eligibility for PCa active surveillance.
Keywords: adult; human tissue; aged; major clinical study; histopathology; nuclear magnetic resonance imaging; prostate specific antigen; patient monitoring; retrospective study; prediction; prostate cancer; gleason score; radiologist; prostatectomy; active surveillance; contrast enhancement; prostate biopsy; multivariate analysis; diffusion weighted imaging; dynamic contrast-enhanced mri; nuclear magnetic resonance scanner; diffusion-weighted imaging; human; male; article; multiparametric mri
Journal Title: European Radiology
Volume: 24
Issue: 12
ISSN: 0938-7994
Publisher: Springer  
Date Published: 2014-12-01
Start Page: 3161
End Page: 3170
Language: English
DOI: 10.1007/s00330-014-3367-7
PROVIDER: scopus
PUBMED: 25100337
DOI/URL:
Notes: Export Date: 2 January 2015 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Junting Zheng
    133 Zheng
  2. Evis Sala
    95 Sala
  3. Chaya S. Moskowitz
    173 Moskowitz
  4. Hedvig Hricak
    333 Hricak
  5. James Eastham
    427 Eastham
  6. Tatsuo Gondo
    8 Gondo